17 U.S. Code § 107 - Limitations on exclusive rights: Fair use
Notwithstanding the provisions of sections 106 and 106A, the fair use of a copyrighted work, including such use by reproduction in copies or phonorecords or by any other means specified by that section, for purposes such as criticism, comment, news reporting, teaching (including multiple copies for classroom use), scholarship, or research, is not an infringement of copyright. In determining whether the use made of a work in any particular case is a fair use the factors to be considered shall include—
(1) the purpose and character of the use, including whether such use is of a commercial nature or is for nonprofit educational purposes [all mirrored content falls under this clause, any ads present are mirrored from the original site, mirrored content earns me no revenue whatsoever];
(2) the nature of the copyrighted work [this is a unique resource for the mentally ill, and preservation of it can be argued to be incredibly important];
(3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole; and
(4) the effect of the use upon the potential market for or value of the copyrighted work. [absolutely none whatsoever, as the original work no longer exists anywhere else (outside of whatever bits and pieces archive.org managed to capture) - the original site was intermittantly completely unavailable for a extended period of time before its SSL certificate expired (and was never renewed), and eventually the site went offline for good, then finally the DNS records were removed at some point prior to May 2018, so at this point it is well beyond the 'dead and rotting' stage]
The fact that a work is unpublished shall not itself bar a finding of fair use if such finding is made upon consideration of all the above factors.

This domain is not controlled by Jerod Poore, and I will NOT continue redirecting traffic from this domain to crazymeds.us [as I formerly did] while Jerod continues with his immature temper tantrum over adblock or continues to fail to maintain his site, fucking over his entire community and countless visitors in the process. [belated clarification: with specific regards to the adblock drama I was referring to Poore at one point replacing his entire site with a single page complaining about the amount of revenue lost to users with ad blocking active, which is something that I took extreme exception to because this affected ALL visitors to the site regardless of if or if not they were actually using ad blocking]
This mirror is unfortunately incomplete (and very slightly outdated), as /CrazyTalk/ was not included when I scraped the site (it was far too large to scrape given the site's extremely poor performance, my wish to avoid worsening the poor performance further, and other factors). If you're looking for a replacement forum, I suggest visiting https://www.crazyboards.org/forums/. There are issues with many of the mirrored pages, I am working on identifying and fixing them, but I do not have the time to address every single issue at this moment (although by now the majority of these issues have been resolved). Dynamic content is obviously completely broken (this is beyond my control), and the loss of /CrazyTalk/ is quite bad given how much good user-generated info was on there, but you have Jerod to "thank" for that. Maybe I'll bring it back online at some point, but it wouldn't be the same as before. For now, I suggest visiting CrazyBoards instead.
Note (Oct 9 2018): Infrequent additional updates regarding the status of this site will be posted on https://info.crazymeds.net

side effects, dosage, how to take & discontinue, uses, pros & cons, and more


US brand name: Symbyax
Generic name: olanzapine and fluoxetine HCl

Class: Antidepressant

1.  FDA Approved Uses of Symbyax

  • Bipolar depression
  • Treatment-resistant depression

2.  Off-Label Uses of Symbyax

Everything or nothing (see comments).

3.  Symbyax’s pros and cons

3.1  Pros

You get the synergistic effect of an antipsychotic and antidepressant in one pill without your doctor trying to figure out how much of which two to give you. The olanzapine and fluoxetine combination has had the most studies and is a truly potent combination. It’s one pill and prescription instead of two. There’s not as much stigma attached to an antidepressant as there is to an antipsychotic. Even if Symbyax doesn’t work out for someone it introduces the concept of the antipsychotic and antidepressant cocktail - even if it’s not the first AD & AP combo in one pill - as a means to treat bipolar and refractory unipolar depression, and for that reason alone this pill is a huge breakthrough.

3.2  Cons

All the side effects of Prozac (fluoxetine) and Zyprexa (olanzapine), two meds people love to hate. It’s an antidepressant with a good chance of making you fat, tired and celibate, and aren’t you happier already just reading that? Being all wrapped up in one pill makes everything easier, but that also means you’ve got limited options for dosage adjustments, especially with the olanzapine component. Not everyone in Bipolarland takes to SSRIs. Both Prozac and Zyprexa mess with how you deal with dietary sugars, but in different ways, so this drug is probably a total no-no for anyone who is diabetic or has the slightest chance of becoming diabetic.

4.  Side Effects

4.1  Typical Side Effects

The usual for SSRIs and atypical antipsychotics - headache, weight gain, nausea, weight gain, dry mouth, weight gain, sweating, weight gain, sleepiness or insomnia, weight gain, diarrhea or constipation, weight gain, and loss of libido. Did I mention weight gain? Most everything will go away after a week or two, but the sleepiness, weight gain and loss of libido might stick around longer. Or permanently.
Things like weight gain, triglycerides, HDL cholesterol, and blood glucose can all be quantified. Libido, how well you sleep, and how tired you feel all day are subjective. When you’ve been living in the bleak and endless despair of bipolar or treatment-resistant unipolar depression how well do you sleep, how much energy do you have, and how often do you get laid?

4.2  Not So Common Side Effects

  • Rash
  • Flu-like symptoms
  • Blurry vision
  • Diabetes

4.3  Freaky Rare Side Effects

Voice alteration, libido increased and aphasia. That’s when you open the world’s weirdest phone sex service.

5.  Interesting Stuff Your Doctor Probably Won’t Tell You

The olanzapine and fluoxetine components of Symbyax have some wildly different pharmacokinetics. How fast they hit you, how long they stick around, and how efficient they work depending upon factors such as ethnicity, gender, age and if you smoke or not - that sort of stuff. They are metabolized by different liver enzymes, so it’s possible that you metabolize one efficiently one the other poorly. On one hand fluoxetine is very egalitarian when it comes to gender and ethnicity, and only a little picky when it comes to age and if you ate anything before taking it. Olanzapine, however, is very picky about your gender, ethnicity, age and if you smoke or not, and couldn’t care less if you ate anything. Thus a young, black, male smoker who takes Zyprexa would need to take four times as much as an older Caucasian in order to get the same benefits from the drug. Eli Lilly said so in Olanzapine. Pharmacokinetic and pharmacodynamic profile. Independent researchers saw the same thing during the CATIE trials and published it in Sex, race, and smoking impact olanzapine exposure.

Symbyax has one of the longest drug-drug interaction lists I’ve seen for a crazy med. As with Luvox, if you take any other meds of any type you need to talk to your pharmacist, read the Drug Interactions section of the PI sheet, and enter everything at drugs.com drug-drug interaction site to make sure there is no nasty surprise.

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6.  Symbyax’s Dosage and How to Take Symbyax

The dosage and titration is the same for both bipolar and treatment-resistant depression. One 6/25 capsule in the evening. That’s 6mg olanzapine & 25mg fluoxetine. Now that Lilly makes a 3/25 size, starting there would probably be a better idea. Give it a week, preferably two, before going up to 6/25.

If you think it’s working, more or less, and you start getting manic, overly anxious, or exhibit other symptoms that indicate more of an antipsychotic is in order, then moving up to the next highest dosage of olanzapine, either 6/25 or 12/25, would be advised.

If you’re still majorly depressed after at least two weeks at 6/25, you can try the 6/50 for another two weeks. If that doesn’t work then it’s either up to the 12/50 or, if your insurance covers it or you otherwise can afford it, one 6/25 and one 3/25 pill. Symbyax comes in 3/25-, 6/25-, 6/50-, 12/25-, and 12/50 mg sizes, so you and your doctor can figure out all the combinations that might work, as long as you don’t exceed 18mg of olanzapine and 75mg of fluoxetine.

If nothing works by the end of two months, then you should start a discontinuation plan and try another combination of antidepressant and antipsychotic.

7.  How Long Symbyax Takes to Work

The guys at Eli Lilly think it takes about a week.

8.  How to Stop Taking Symbyax

I haven’t figured out the mechanics of discontinuation. Taking an antipsychotic tends to make SSRI discontinuation less of an issue, but in combination? The withdrawal syndrome is mentioned in the PI sheet, but only in the context that it happens to people who suddenly stop taking SSRIs, and fluoxetine is a serotonin-[barely]-selective reuptake inhibitor. You may have to switch to regular Prozac for purposes of discontinuation, and Prozac is the easiest of the SSRIs from which to discontinue. Honestly, it’s highly unlikely you’d get full-on SSRI discontinuation syndrome] if you were to stop taking Symbyax too quickly. If you were taking a 50-75mg a day dosage of fluoxetine and quit taking Symbyax completely without replacing it with an SSRI, [[MedClass/SNRI, or one of the more serotonergic TCAs you’d probably experience discontinuation symptoms.

9.  Symbyax’s Half-Life & Average Time to Clear Out of Your System

30 hours olanzapine component (see Interesting Stuff Your Doctor Probably Won’t Tell You, the range can be 6 to 60 hours) and 9.3 days for the fluoxetine component. Thus you’re clear of the Zyprexa part, on average, in a little over six days. But it takes six weeks to get completely clean of Prozac.

10.  Days to Reach a Steady State

About one week for the olanzapine component and four to five weeks for the fluoxetine component.

11.  Shelf life

3 years - based on 3 years being the shelf life of each of its component parts


Approved in January 2004, this is was the first med approved only for bipolar disorder (even lithium had prior approvals for other things) and specifically for bipolar depression. Seroquel is now approved for bipolar depression, so its no longer alone in that regard. Symbyax is not really a new med, but a combination of Prozac and Zyprexa, and while the combination of an atypical antipsychotic and a modern antidepressant was getting all the buzz in psychiatric circles in the early-to-mid 2000s - which led to Abilify being approved as an add-on to antidepressants for treatment-resistant depression - it’s not all that new. Etrafon / Triavil is a combination of the tricyclic antidepressant Elavil (amitriptyline) and the standard antipsychotic Trilafon (perphenazine). So there has been a previous version of Symbyax around for about 30 years.

The combination of olanzapine and fluoxetine is the most studied combination of atypical / second-generation antipsychotic and modern antidepressant. The combination of an antidepressant and antipsychotic is a potent way of dealing with depression. The thing is, just because this is the most studied combination doesn’t mean it’s the right one for you. Sure, start here if you have no objections to an SSRI, or either of its component ingredients. Really. This is as good a place as any to begin. Zyprexa is a great med for stomping out breakthrough manias, so while mania is always possible, it’s probably a lot less likely than if you combine Abilify or Geodon with an antidepressant. But if it doesn’t work, don’t give up on the idea of the synergistic effect of an antipsychotic and antidepressant. Each person who requires such a cocktail is different and may require a different combination to achieve psychopharmacological Nirvana. My personal magic combo was Strattera and Risperdal.

As far as off-label applications go, there’s nothing out there. It’s kind of pointless really. Then again, both Prozac and Zyprexa have been tried for a bunch of different brain cooties. As with bipolar and treatment-resistant depression, olanzapine has been used to augment SSRIs to enhance its effects in things like OCD and SSRIs have been added to SGAs to help them. Symbyax is just another option to explore.

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13.  Symbyax Ratings, Reviews, & Other Sites of Interest

13.1  Rate Symbyax

Give your overall impression of Symbyax on a scale of 0 to 5.

Get all critical about Symbyax

3 stars Rating 2.5 out of 5 from 24 criticisms.
Vote Distribution: 9 – 0 – 1 – 3 – 5 – 6

13.2  Rate this article

If you’re still feeling judgmental as well as just mental1, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Symbyax (olanzapine and fluoxetine HCl) Synopsis

4 stars Rates 3.8 out of 5 from 10 value judgments.
Vote Distribution: 1 – 0 – 0 – 1 – 5 – 3

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Pages and Forum Topics Google Thinks are Relevant to Your Mental Health

13.3  Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, check for drug-drug interactions

Drugs.com’s drug-drug and drug-food interaction checker

It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.

These will stick around longer than AD side effects. More ways to be stuck-up at Straitjacket T-shirts. Individual stickers only $5. Packs of 10 and 50 available.
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You don’t have to buy anything. Look around the store. Tweet what you like to your Pinbook Circle. Do you have anything better to do right now?

13.4  Discussion board

If you have any questions not answered here, please see the Crazymeds Symbyax discussion board.

Keep Crazymeds on the air.
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14.  References

  1. Symbyax (olanzapine and fluoxetine HCl) Full US Prescribing Information

Physicians’ Desk Reference Edition 64 � 2010. Published by Medical Economics Company.

1 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!

If you have any questions not answered here, please see the Crazymeds Symbyax discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.net)

Last modified on Tuesday, 05 May, 2015 at 10:11:21 by JerodPoorePage Authors , Jerod PooreDate created
“Symbyax (olanzapine and fluoxetine HCl): a Review for the Educated Consumer” by Jerod Poore is copyright © Jerod PoorePublished online 2011/03/18
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Symbyax, and all other drug names on this page and used throughout the site, are a trademark of someone else. Symbyax’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.

Page design and explanatory material by Jerod Poore, copyright © 2003 - 2015. All rights reserved.
Keep up with Crazymeds and and/or my slow descent into irreparable madness boring life. Pick your preferred social media target(s):

Almost all of the material on this site is by Jerod Poore and is copyright © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, and 2015 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.

All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList, NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
Crazymeds is optimized for ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!

‘Everything is true, nothing is permitted.’ - Jerod Poore

1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

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